Pure cut vs. Endocut in endoscopic biliary sphincterotomy: A systematic review and meta-analysis of Randomized Clinical Trials.

Luiza Bicudo de Oliveira, M. Funari, A. So Taa Kum, A. Bestetti, V. Brunaldi, T. Franzini, E. Moura, L. M. Baroni, M. F. de Carvalho, W. Bernardo, E. D. de Moura
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Abstract

Introduction: Biliary sphincterotomy is a crucial step in endoscopic retrograde cholangiopancreatography (ERCP), a procedure known to carry a 5-10% risk of complications. The relationship between Pure cut, Endocut, post-ERCP pancreatitis (PEP) and bleeding is unclear. This systematic review and meta-analysis compares these two current types and their relationships with adverse events. Methods: This systematic review involved searching articles in multiple databases until August 2023 comparing pure cut versus Endocut in biliary sphincterotomy. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results: A total of 987 patients from four randomized controlled trials were included. Overall pancreatitis: a higher risk of pancreatitis was found in the Endocut group than in the pure cut group (P=0.001, RD=0,04 [0.01,0.06]; I2=29%). Overall immediate bleeding: statistical significance was found to favour Endocut, (P=0.05; RD=-0.15 [-0.29, -0.00]; I2=93%). No statistical significance between current modes was found in immediate bleeding without endoscopic intervention (P=0.10; RD=-0.13 [-0.29, 0.02]; I2=88%), immediate bleeding with endoscopic intervention (P=0.06; RD=-0.07 [-0.14,0,00]; I2=76%), delayed bleeding (P=0.40; RD=0.01 [-0.02,0.05]; I2=72%), zipper cut (P=0.58; RD= -0.03 [-0.16,0.09]; I2= 97%), perforation (P= 1.00; RD= 0.00 [-0.01,0.01]; I2= 0%) and cholangitis (P= 0.77; RD= 0.00 [-0.01,0.02]; I2= 29%). Conclusion: The available data in the literature shows that Endocut carries an increased risk for PEP and does not prevent delayed or clinically significant bleeding, although it prevents intraprocedural bleeding. Based on such findings, pure cut should be the preferred electric current mode for biliary sphincterotomy.
内镜胆道括约肌切开术中的纯切割与 Endocut:随机临床试验的系统回顾和荟萃分析。
导言:胆道括约肌切开术是内镜逆行胰胆管造影术(ERCP)的关键步骤,已知该手术有 5-10% 的并发症风险。纯切、Endocut、ERCP术后胰腺炎(PEP)和出血之间的关系尚不清楚。本系统综述和荟萃分析比较了目前这两种类型及其与不良事件的关系:本系统综述在 2023 年 8 月之前在多个数据库中搜索了比较胆道括约肌切开术中纯切与 Endocut 的文章。荟萃分析遵循系统综述和荟萃分析首选报告项目(PRISMA):结果:共纳入了四项随机对照试验中的 987 名患者。总体胰腺炎:发现 Endocut 组发生胰腺炎的风险高于纯切割组(P=0.001,RD=0,04 [0.01,0.06];I2=29%)。总体即刻出血量:Endocut更具有统计学意义(P=0.05;RD=-0.15 [-0.29, -0.00];I2=93%)。在无内镜干预的即刻出血(P=0.10;RD=-0.13 [-0.29, 0.02];I2=88%)、有内镜干预的即刻出血(P=0.06;RD=-0.07 [-0.14,0,00];I2=76%)、延迟出血(P=0.40;RD=0.01 [-0.02,0.05];I2=72%)、拉链切断(P=0.58;RD= -0.03 [-0.16,0.09];I2= 97%)、穿孔(P= 1.00;RD= 0.00 [-0.01,0.01];I2= 0%)和胆管炎(P= 0.77;RD= 0.00 [-0.01,0.02];I2= 29%):现有文献数据显示,Endocut 会增加 PEP 风险,虽然能防止术中出血,但不能防止延迟出血或有临床意义的出血。基于这些研究结果,胆道括约肌切开术应首选纯切割电流模式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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